ARMSTRONG STUDY ABROAD SIENA, ITALY

June 22- July 20, 2013
$4450 plus tuition
Please Note that the cost of the trip increased for any applicant after 3/7/2013
Complete the form below and submit your $200 nonrefundable deposit to Kristin Kasting in Hawes 210.

* Required

APPLICANT INFORMATION

Last Name (as it appears in passport)
*

First Name (as it appears in passport)
*

Middle Name (as it appears in passport)
*

Passport Number (if available)

Country of Citizenship
*

Phone Number
*

Alternate Phone Number

Email Address
*

Alternate Email Address
*

Date of Birth (mm/dd/yyyy)
*

Student ID Number (i.e. 907 number)

ACADEMIC INFORMATION

College/University currently Attending
*

Classification (at time of program)

Freshman

Sophmore

Junior

Senior

Graduate

Major

Current GPA
*

COURSE SELECTION AND REGISTRATION INFORMATION

Choose 2 Class To Be Enrolled
*

SABR 2960 Study Abroad

HIST 5480 History of Italy

HIST 5470 Gender Studies

PHIL 2010 Introduction to Philosophy

PHIL 3120 Medieval Philosophy

FINANCIAL INFORMATION

I am aware that the deadline for submission of this application is January 31, 2013, and I agree to abide by the deadlines for fee payment as follows:
* $1500 due by February 15, 2013
* $1350 due by March 15, 2013
* Balance Due by April 15, 2013. It is presumed the balance will be $1000.00. However, the balance often does adjust due to a change in currency exchange rate (increase or decrease). In addition, the balance occasionally adjusts upward due to an increase in transportation fees (e.g., airline fuel surcharge. However, the total price of the program will not increase by more than $200.00.
I further acknowledge and accept the schedule for refunds, should I withdraw from the program, and accept the penalties as follows:
* The $200 deposit is non-refundable
* Withdrawal prior to 2/15/2013, student forfeits 25% of cost of trip minus the deposit.
* Withdrawal after 2/15/2013 but prior to 03/15/2013, student forfeits 50% of cost of trip minus deposit.
* Withdrawal after 3/15/2013, student forfeits 100% of cost of trip.
Note: All withdrawals must complete the online withdrawal form in order for refunds to be processed. The date The Office of International Education receives the withdrawal is the date of the withdrawal. In addition, the program directors reserve the right to cancel this program at any time, with full refunds going to each applicant.
There will be a $25 fee assessed for any late payment.

AUTHORIZATION AND WAIVER OF LIABILITY

I acknowledge that participation in a study abroad program involves some risk of injury, illness, or loss of personal property. I agree to release and forever discharge the institution through which I am registering for the program, Armstrong Atlantic State University, and the Board of Regents of the University System of Georgia, its members individually, and its officer, agents, and employees, from any and all claims, demands, rights, and causes of action of whatever kind of nature, arising from and by reason of any and all known and unknown foreseen and unforeseen bodily and personal injuries, including death, damages to property and the consequences thereof, resulting from my participation in the Italy Study Abroad Summer 2013.
I hereby agree to maintain accident and health insurance in force and effect for the entire duration of my participation in the Study Abroad program. I further certify that, to the best of my knowledge, I am in good health and physically capable of undertaking an intensive program of foreign study; any medical or health related problems have been explicitly described in this application. I understand that participants in the Study Abroad program are required to exhibit appropriate conduct while participating in the program and that the program director has full authority to determine the appropriateness of participants’ conduct. Appropriateness will be judged based on local law, regulations, customs, and Armstrong rules and regulations.
I further agree that I shall be subject to the supervision and authority of the faculty in charge and to standards of conduct stipulated by the faculty in charge. I acknowledge that the supervising faculty or program director has sole authority to make decisions regarding the continued participation of any individual in the program whose conduct may necessitate disciplinary action. I acknowledge that if the director finds my conduct inappropriate, he/she may at his/her discretion order my early dismissal from the program. Dismissal means that I will be sent home as soon as is practical in the director’s judgment, will be billed for the cost of the unscheduled early trip, and will receive no refund on participant fees paid in to the program. I further authorize the supervising faculty or program director to obtain and provide at my expense any medical treatment and/or services that I may require during the study abroad program.

APPLICATION ELECTRONIC SIGNATURE

I understand that submitting an application for this Study Abroad program does not guarantee acceptance into the program, that candidates must meet program requirements and be approved by their advisor and that participation is subject to availability and at the discretion of the Study Abroad Leaders. I certify that all the above information is true and correct to the best of my knowledge. I have read, understood, and fully accept all of the above terms for participation in the Italy Study Abroad 2013.